1. Field of the Invention
The present invention relates to a gastrostomy catheter introducing device for percutaneous endoscopic gastrostomy.
2. Description of the Related Art
A patient incapable of oral injection is nourished by artificially feeding the patient through a nourishing tube inserted through the nose into the stomach. The nourishing tube extending outside from the nose spoils the appearance of the patient and gives a strong feeling of wrongness to the patient.
A nourishing method is employed to avoid spoiling the appearance of the patient and giving a feeling of wrongness to the patient. This nourishing method establishes a gastric fistula in the stomach by gastrostomy and supplies a nourishing liquid into the stomach through a catheter for gastrostomy (hereinafter referred to as “gastrostomy catheter) into the stomach.
Endoscopic gastrostomy methods are classified roughly into pull/push methods and introducer methods. The pull/push method catches a wire percutaneously inserted into the stomach with a snare or the like under endoscopic observation, pulls the guide wire outside through the mouth, connects a gastrostomy catheter to the guide wire, and pulls the gastrostomy catheter together with the guide wire into the stomach. A pull method pulls a gastrostomy catheter connected to the guide wire outside the stomach. A push method pushes a gastrostomy catheter put on the guide wire into the stomach.
The introducer method percutaneously thrusts a trocar having an inner needle and a sheath into the stomach, extracts the inner needle from the sheath, inserts a balloon gastrostomy catheter provided with a balloon through the sheath into the stomach, and inflates the balloon to fixate the balloon gastrostomy catheter.
The pull/push method is an easy method of establishing a gastric fistula. However, the pull/push method needs to pass the gastrostomy catheter through the oral cavity and the pharynx. Therefore, the pull/push method causes inflammation around the gastric fistula after gastrostomy unless the pull/push method is carried out by a clean operation.
The introducer method inserts the gastrostomy catheter into the stomach from outside the body and hence can be achieved by a clean operation. Therefore, it is expected that inflammation around the gastric fistula can be prevented after gastrostomy. However, the introducer method can use only the thin balloon gastrostomy catheter, the gastric fistula needs to be expanded at an early stage and the balloon gastrostomy catheter needs to be changed frequently. Thus the introducer method requires troublesome management after the operation.
An improved introducer method developed through the improvement of the introduction method is proposed in “Atarashii Irou Zousetsu-hou (direct method) to Irou Kansen (New Gastrostomy and Fistula Infection)”, Zaitaku Iryou to Naishikyou Chiryou, pp. 79-89, July, 2005. This improved introducer method detains a thick bumper type gastrostomy catheter, such as a button type gastrostomy catheter used by the pull/push method, in the stomach.
The improved introducer method fixates three or four parts of the stomach to the abdominal wall with threads or T-fasteners to restrain the stomach from moving relative to the abdominal wall before thrusting a trocar into the stomach. Then, the improved introducer method thrusts a thin trocar through a central part of the fixed part of the stomach into the stomach, detains a guide wire on the stomach, incises the skin to form an opening, bluntly expands the opening to introduce air sufficiently into the stomach, and then pushes a gastrostomy catheter into the stomach.
The improved introducer method needs to supply a sufficient amount of air into the stomach to fixate the stomach to the abdominal wall and to secure a sufficient field of view which can be viewed through an endoscope. Moreover, since air pressure in the stomach is only means for holding the front wall of the stomach against pressure applied to the front wall of the stomach when the gastrostomy catheter is thrust into the stomach, the front wall of the stomach is moved near to the rear wall of the stomach and a field view which can be viewed through an endoscope cannot be secured in some cases when the gastrostomy catheter is thrust into the stomach. It is possible that excessive air supply into the stomach causes the leakage of air into the abdominal cavity (tympanites) and gastrostomy cannot be achieved.
The improved introducer method needs an additional gastric wall fixing implements for gastric wall fixation essential to the improved introducer method and may possibly puncture other adjacent organs, such as the liver and the transverse colon, because the improved introducer method needs to puncture several parts of the stomach and the abdominal wall. If the parts of the gastric wall fixed to the abdominal wall are excessively spaced apart, the gastric wall will excessively slacken and, in some cases, the gastrostomy catheter cannot be successfully inserted into the stomach. If the parts of the gastric wall fixed to the abdominal wall are excessively close to each other, the gastric wall cannot be expanded and, in some cases, the gastrostomy catheter cannot be successfully inserted into the stomach.